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• W2894861363 abstract "SESSION TITLE: Education, Research, and Quality Improvement 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 pm - 02:00 pm PURPOSE: National quality metrics such as US News & World Report's (USNWR) mortality metric may be sensitive to physician documentation of comorbid conditions included in risk adjustment models. Many Vizient Clinical Database mortality estimation models (representing 97% of US academic medical centers) include malnutrition. Dietitians in our hospital observed that physicians often fail to document malnutrition. We evaluated 1) the extent to which USNWR-defined pulmonology patients were cared for on pulmonary services versus other services and 2) the degree to which our USNWR Pulmonology mortality score might improve with complete malnutrition documentation. METHODS: Data were extracted for discharges from Johns Hopkins Hospital between July 2016-Sept 2017 in 39 Medicare severity-diagnosis related groups (MS-DRGs) used to define the USNWR Pulmonology specialty. To mirror the USNWR population, we restricted to individuals aged 65 or greater with Medicare payer and not transferred from another hospital. We identified patients cared for on a pulmonology service (24-bed Medical Intensive Care Unit and an advanced lung disease service) from electronic medical record (EMR) “service” and “location” data. We identified guideline-based dietitian diagnosis of malnutrition from the EMR's standardized nutrition note. Discharge records were queried for malnutrition International Classification of Diseases, 10th Revision (ICD-10) codes. Vizient 2016 mortality models were used to calculate expected mortalities. RESULTS: We identified 623 discharges in the USNWR Pulmonology population. This group was 49% female, with median age 73 (IQR 69 - 80.5), median length of stay 5 days (IQR 3-10 days), and in-hospital mortality 8.7%. Of these, 27% were cared for on, and 16% were discharged from, a pulmonology service. Most (54%) were discharged from other medicine services: 44% from general medicine wards and the remainder from subspecialty services. The most common MS-DRGs were sepsis (33%), pneumonia and pleurisy (10%), and COPD (10%). Among 513 discharges with finalized coding data, 15% included a dietitian diagnosis of malnutrition present on admission. Of these, 47% were coded with a malnutrition ICD-10 code. When malnutrition was added to the Vizient mortality risk model for the remaining 53%, the observed/expected mortality for the overall population decreased from 1.16 to 1.10. This is nearly the change required to improve one step in the USNWR Pulmonology survival score, which may result in a change in ranking. CONCLUSIONS: At JHH, most patients in the USNWR Pulmonology population were never on a pulmonary service. About half of patients with malnutrition were not coded as such. CLINICAL IMPLICATIONS: Efforts to improve performance on pulmonology mortality metrics may need to be implemented broadly, rather than targeted only at specialty services. Improved documentation of malnutrition may meaningfully impact USNWR rankings. DISCLOSURES: No relevant relationships by Stephen Berry, source=Web Response no disclosure on file for Lee Biddison; No relevant relationships by David Hager, source=Web Response no disclosure on file for Shanshan Huang; No relevant relationships by Kathleen McDonald, source=Web Response No relevant relationships by Samantha Merck, source=Web Response No relevant relationships by Tyler Wintermeyer, source=Web Response" @default.
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• W2894861363 date "2018-10-01" @default.
• W2894861363 modified "2023-09-25" @default.
• W2894861363 title "MORTALITY ESTIMATES OF PULMONOLOGY SPECIALTY INPATIENTS: DOCUMENTING MALNUTRITION" @default.
• W2894861363 doi "https://doi.org/10.1016/j.chest.2018.08.488" @default.
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